Budget-friendly program helps omit sedation for pediatric MR

St. Jude Children's Research Hospital reports success in using a targeted educational approach to teach young sickle cell disease patients to remain motionless during MRI scans, making the process safer.

Implementation of a preparation and support procedure helped reduce the need for sedation among children with sickle cell disease undergoing MR exams, according to a study published in Pediatric Radiology.

Children with sickle cell disease require periodic MR studies to assess ischemic brain injury, detect or monitor neurological complications and quantify hepatic iron. However, the use of sedation presents additional risks such as vaso-occlusive complications for this population. Preventive measures to reduce risk, including blood transfusions, add to the cost of the exam.

Thus, St. Jude Children’s Research Hospital in Memphis, Tenn., developed a preparation and support procedures program for patients ages five to 12 years old with sickle cell disease undergoing MR imaging of the brain or liver. The program is designed to educate and prepare children and their families for the exam and aims to reduce the need for sedation.

Katherine R. Cejda, child life specialist at St. Jude, and colleagues devised a retrospective study to evaluate whether the program affected the ability of patients to undergo MR without sedation.

Between September 2008 and November 2009, treating clinicians referred children to the program. Referrals were limited to stable children and caregivers who could meet with the child life specialist. “During this meeting, the MRI procedure was explained to the child and his or her caregivers, and the child’s prior experience (anxiety level, use of sedation, etc.) with MRI testing was reviewed.”

The child life specialist prepared the child for the exam through use of a small model MRI system and showed him or her pictures of the MR suite and recordings of MR sounds. She also assigned the child a job, such as holding still or completing a 10-second breath-hold, and encouraged him or her to practice the job. An individualized coping plan was developed for each child and could include presence of the child life specialist or caregiver in the suite or listening to a book or music during the exam.

“An MR test was defined as successful when it yielded interpretable results (by a neuroradiologist or pediatric radiologist) and did not require the use of sedation/anesthesia,” wrote Cejda and colleagues.

Although a total of 87 children with sickle cell disease underwent MRI during the study period, 16 were omitted from the study because the clinician prescribed sedation. The median age of the remaining 71 patients was 9.9 years.

The preparation and support program was offered to 33 children, with a median age of 8.9 years. There were no significant differences in gender or prior MR experiences between participants and non-participants.

“Children who underwent [preparation and support procedures] had 4.1 times the odds of completing an interpretable MRI exam compared to children who did not.” The odds of successful completion of the exam increased to 8.5 after researchers adjusted for age. Cejda and colleagues acknowledged the possibility of selection bias in the study as it did not use a prospective randomized design.

The St. Jude team emphasized the relatively low cost of the program: $600 for the model MR system and less than $200 for photo books. The cost of an MR-compatible movie system ranges from $4,000 to $7,000. Other options, such as video goggles or full scale mock systems, may not fit into the budgets of many hospitals, according to the authors.

“The preparation and support program helped improve coping with MRI diagnostic procedures within the hospital environment while minimizing the risks from sedation known to be associated with children with sickle cell disease. The low cost of implementation and ease of use are important advantages when compared with other published methods,” concluded Cejda et al.